Provider Demographics
NPI:1689734246
Name:JACQUELINE W. MULLER, M.D., P.C.
Entity Type:Organization
Organization Name:JACQUELINE W. MULLER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-832-8362
Mailing Address - Street 1:30 DELEVAN LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1302
Mailing Address - Country:US
Mailing Address - Phone:212-832-8362
Mailing Address - Fax:
Practice Address - Street 1:764 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-832-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183068207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY456219OtherAETNA
NY2C4802OtherHEALTH NET
NY22L201OtherBCBS
NY1111683OtherUNITED HEALTH CARE
NY456219OtherAETNA
NY22L201Medicare ID - Type Unspecified